http://en.wikipedia.org/wiki/Drug_test

Hi kstauffer, Welcome.

You bring up many good points.

Many doctors are changing their policies regarding longterm pain medications. The reasons are often political rather than medical.
Google: politics of pain and the related searches that appear at the bottom of that page.

One option is methadone.
Google: methadone for chronic pain and related searches for more information. It can be very effective for treating chronic pain, but like other opioids, it is not risk-free. Research thoroughly and discuss with your doctor.

You might consider seeing a pain management specialist (if you haven't/aren't already) to explore alternatives to medication.

I would also recommend The Intractable Pain Patient's Handbook for Survival by Dr. Forest Tennant, which can be downloaded free.

Lack of sex drive and lethargy can/may be due to hormone imbalance caused by intractable pain and/or longterm opioid use. This can have a significant effect on quality of life issues as well. Here are some further detailed articles by Dr. Tennant on this:

http://www.practicalpainmanagement.c...-pain-patients

http://www.practicalpainmanagement.c...tractable-pain

http://www.practicalpainmanagement.c...in-update-2010

and my own experiences:
http://neurotalk.psychcentral.com/thread156416.html

Doc